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Traveling With Dementia

Most people have become accustomed to the rhythm of airport security checks—lap top out, jacket off, shoes off, belt and any metals onto the tray, and then waiting patiently for instructions. These routines become second nature, except when some cognitive impairment like dementia starts eroding this familiarity. Traveling alone is a necessity for most people but we need to rethink how viable this is with early stage dementia.

People with dementia might not feel comfortable taking their jacket off or their shoes. Such familiar behaviors in unfamiliar surroundings are likely to agitate the older adult, and a security checkpoint is not the most accommodating venue to address anxiety and agitation. These scenarios will become more frequent with an increasing prevalence of dementia and other cognitive disorders. And, it is not just at the security gate.

On Friday, May 3, 2013, an 83-year-old Victoria Kong walked past the assistance agent waiting to meet her at the gate as she deplaned from her flight from Barbados to Washington D.C. She was found the following Monday in a wooded area about 200 yards from the airport perimeter. She died of hyperthermia. Victoria King suffered from dementia and wondered out of the airport oblivious to the pickup arrangements made for her by her relatives. Most airlines do not have an escort policy/program in place for adults, traveling alone with cognitive impairment. Airlines only have escort policies/programs in place for minor children traveling alone.

In addition, most airlines do not include dementia as needing medical clearance, and although there are some provisions offered by airports and some airlines—in most cases dictated by law—these provisions are insufficient given the type of problems likely to be experienced by persons suffering from dementia. The increasing prevalence of dementia in the population and the lack of training of security personnel and flight attendants make this a recipe for more common friction.

Although in the early stages of dementia older adults might behave normally, this sense of normalcy might evaporate in an unfamiliar environment or confusing situations—as air travel has increasingly become. New faces, new environments, a change in daily routine, not to mention a time zone change, can prove to be a challenge for the dementia traveller.

You might get escort passes to help the person on board and then someone at the other end to escort the person out of the airport, but the flight itself might prove disorientating. Flight attendants should not be dealing with—at best—agitated passengers.

If we are to address this growing friction, education needs to come from both ends. Caregivers and family members need to understand the limitations of their loved one and that unfamiliar and stressful situations compound cognitive unease. Air travel is a stressful event at the best of times. On the other side, security personnel and air flight attendants need to learn to identify and defuse agitation because of dementia. Although it might be difficult to distinguish anxiety and agitation because of dementia from other types of erratic behavior (alcohol, drugs or stress), the only way to reduce these misunderstandings is by not putting the older adult with dementia in that position in the first place.